Uterine Fibroids

Topic Overview

What are uterine fibroids?

Your doctor may call them fibroid
tumors, leiomyomas, or myomas. But fibroids are not cancer. You do not need to
do anything about them unless they are causing problems.

Fibroids
are very common in women in their 30s and 40s. But fibroids usually do not cause problems.
Many women never even know they have them.

What causes uterine fibroids?

Doctors are not sure
what causes fibroids. But the female hormones
estrogen and
progesterone seem to make them grow. Your body makes
the highest levels of these hormones during the years when you have periods.

Your body makes less of these hormones after you stop having
periods (menopause). Fibroids usually shrink after menopause
and stop causing symptoms.

What are the symptoms?

Often fibroids do not cause
symptoms. Or the symptoms may be mild, like periods that are a little heavier
than normal. If the fibroids bleed or press on your organs, the symptoms may
make it hard for you to enjoy life. Fibroids make some women have:

Long, gushing periods and cramping.

Fullness or pressure in their belly.

Low back
pain.

Pain during sex.

An urge to urinate often.

Heavy bleeding during your periods can lead to
anemia. Anemia can make you feel weak and
tired.

Sometimes fibroids can make it harder to get pregnant. Or
they may cause problems during pregnancy, such as going into early labor or
losing the baby (miscarriage).

How are uterine fibroids diagnosed?

To find out if
you have fibroids, your doctor will ask you about your symptoms. He or she will
do a
pelvic exam to check the size of your uterus.

Your doctor may send you to have an
ultrasound or another type of test that shows pictures
of your uterus. These help your doctor see how large your fibroids are and
where they are growing.

Your doctor may also do blood tests to
look for anemia or other problems.

How are they treated?

If your fibroids are not
bothering you, you do not need to do anything about them. Your doctor will
check them during your regular visits to see if they have gotten bigger.

If your main symptoms are pain and heavy bleeding, try an
over-the-counter pain medicine like ibuprofen, and ask
your doctor about birth control pills. These can help you feel better and make
your periods lighter. If you have anemia, take iron pills and eat foods that
are high in iron, like meats, beans, and leafy green vegetables.

If your symptoms bother you a lot, you may want to think about surgery.
Most of the time fibroids grow slowly, so you can take time to consider your
choices.

There are two main types of surgery for fibroids. Which
is better for you depends on your age, how big your fibroids are, where they are, and
whether you want to have children.

Surgery to take out the fibroids is called
myomectomy. Your doctor may suggest it if you hope to
get pregnant or just want to keep your uterus. It may improve your chances of
having a baby. But it does not always work, and fibroids may grow
back.

Surgery to take out your uterus is called
hysterectomy. This is the most common surgery for
fibroids. And it is the only way to make sure that fibroids will not come back.
Your symptoms will go away, but you will not be able to get pregnant.

It is normal to have mixed feelings about hysterectomy.
Some women are sad to lose part of what makes them a woman. Other women just
want their symptoms to go away. If you are thinking about hysterectomy, learn
all you can about it. This will help you make the choice that is right for you.

There are
a number of other ways to treat fibroids. One treatment is called
uterine fibroid embolization. It can shrink fibroids.
It may be a choice if you do not plan to have children but want to keep your
uterus. It is not a surgery, so most women feel better soon. But fibroids may
grow back.

If you are near menopause, you might try medicines to
treat your symptoms. Heavy periods will stop after menopause.

Cause

The exact cause of
uterine fibroids is not known. Fibroids begin when
cells overgrow in the muscular wall of the uterus.

After a fibroid
develops, the hormones
estrogen and
progesterone appear to influence its growth. A woman's
body produces the highest levels of these hormones during her childbearing
years. After
menopause, when hormone levels decline, fibroids
usually shrink or disappear.

Symptoms

Uterine fibroid
symptoms can develop slowly over several years or rapidly over several months.
Most women with uterine fibroids have mild symptoms or none at all and never
need treatment.

For some women, uterine fibroid symptoms become a
problem. Pain and heavy menstrual bleeding are the most common symptoms. In
some cases, difficulty becoming pregnant is the first sign of fibroids. The type of symptoms women have can depend on where the fibroid is located in the uterus.

What Happens

Uterine fibroids can grow on the
inside wall of the uterus,
within the muscle wall of the uterus, or on the
outer wall of the uterus. They can alter the shape of the uterus as they grow.
Over time, the size, shape, location, and symptoms of fibroids can change.

As women age, they are more likely to have
uterine fibroids, especially from their 30s and 40s through
menopause (around age 50).
Uterine fibroids can stay the same for years with few or no
symptoms, or you can have a sudden, rapid growth of fibroids.

Fibroids do not grow before the start of menstrual periods (puberty).
They sometimes grow larger during the first trimester of pregnancy, and they
usually shrink for the rest of a pregnancy. After
menopause, when a woman's hormone levels drop,
fibroids usually shrink and don't come back.

Complications of
uterine fibroids aren't common. They include:

Anemia from
heavy bleeding.

Blockage of the urinary tract or bowels, if a
fibroid presses on them.

Infertility, especially if the fibroids grow inside the uterus and change the shape of the uterus or the location of the fallopian
tubes.

Ongoing low back pain or a feeling of pressure in the lower
abdomen (pelvic pressure).

Infection or a breakdown of uterine
fibroid tissue.

Fibroids can cause problems during pregnancy, such
as:

The need for a
cesarean section delivery. This is the most common
effect of fibroids on pregnancy.1

Premature labor and delivery.

Miscarriage. This can happen when fibroids are located inside the uterus.

Laparoscopy
may be used to look for and locate fibroids on the outer surface of the uterus
before removal (myomectomy).

Additional testing

If you have severe pain,
bleeding, or pelvic pressure or have had repeat miscarriages or trouble
becoming pregnant, you will probably have other tests to look for
other possible causes of your symptoms. Two examples of possible causes are endometriosis and pelvic inflammatory disease (PID).

And tests for specific symptoms, such as
urinary or bowel problems, may be needed to diagnose the problem or to help build a
treatment plan.

Treatment Overview

Most
uterine fibroids are harmless, do not cause symptoms,
and shrink with
menopause. But some fibroids are painful, press on
other internal organs, bleed and cause
anemia, or cause pregnancy problems. If you have a
fibroid problem, there are several treatments to consider. Fibroids can be
surgically removed, the blood supply to fibroids can be cut off, the entire
uterus can be removed, or medicine can temporarily shrink fibroids. Your choice
will depend on whether you have severe symptoms and whether you want to
preserve your fertility.

Watchful waiting for minimal fibroid symptoms or when nearing menopause

If you have uterine fibroids but you have few or no
symptoms, you don't need treatment. Instead, your doctor will
recommend
watchful waiting. This means that you will have
regular pelvic exams to check on fibroid growth and symptoms. Talk with your
doctor about how often you will need a checkup.

If
you are nearing
menopause, watchful waiting may be an option for you,
depending on how tolerable your symptoms are. After menopause, your
estrogen and
progesterone levels will drop, which causes most
fibroids to shrink and symptoms to subside.

For heavy menstrual bleeding or pain

If you have
pain or heavy menstrual bleeding, it may be from a bleeding
uterine fibroid. But it may also be linked to a simple
menstrual cycle problem or other problems. For more
information, see the topic
Abnormal Uterine Bleeding. The following medicines are used to relieve heavy
menstrual bleeding, anemia, or painful periods, but they do not shrink
fibroids:

An intrauterine device (IUD) that releases small amounts of the hormone progesterone into the uterus may reduce heavy menstrual bleeding.

A
progestin shot (Depo-Provera) every 3 months may
lighten your bleeding. It also prevents pregnancy. Based on different studies,
progestin may shrink fibroids or may make them grow.3 This might be different for each
woman.

Iron supplements, available without a prescription, are an
important part of correcting
anemia caused by fibroid blood loss.

For infertility and pregnancy problems

If you have
fibroids, there is no way of knowing for certain whether they are affecting
your fertility. Fibroids are the cause of infertility in only a small number of women. Many women with fibroids have no trouble getting pregnant.4

If a fibroid distorts the wall of the
uterus, it can prevent a fertilized egg from implanting in the uterus.
This may make an
in vitro fertilization less likely to be successful,
if the fertilized egg doesn't implant after it is transferred to the
uterus.4

Surgical fibroid removal,
called
myomectomy, is the only fibroid treatment that may
improve your chances of having a baby.4 Because
fibroids can grow again, it is best to try to become pregnant as soon as
possible after a myomectomy.

For severe fibroid symptoms

If you have
fibroid-related pain, heavy bleeding, or a large
fibroid that is pressing on other organs, you can consider shrinking the
fibroid, removing the fibroid (myomectomy), or removing the entire uterus
(hysterectomy). After all treatments except hysterectomy, fibroids may grow
back. Only myomectomy is recommended for women who have childbearing
plans.

To shrink a fibroid for a short time, hormone therapy with a
gonadotropin-releasing hormone analogue (GnRH-a) puts
the body in a state like
menopause. This shrinks both the uterus and the
fibroids. Fibroids grow back after GnRH-a therapy has ended. GnRH-a therapy can help to:

Shrink a fibroid before it is surgically removed. This lowers
your risk of heavy blood loss and scar tissue from the surgery.

Provide short-term relief as a "bridge therapy" if you are nearing
menopause. (Fibroids naturally shrink after menopause.)

GnRH-a therapy should be used for only a few months,
because it can weaken the bones. It also may cause unpleasant menopausal
symptoms.

To surgically remove fibroids,
myomectomy can often be done through one or more small
incisions using
laparoscopy or through the vagina (hysteroscopy). Some surgeries can be done using robotic tools. Sometimes, a larger abdominal incision
is needed depending on where the fibroid is located in the uterus.
Myomectomy preserves the uterus,
and it makes pregnancy possible for some women.

To surgically remove the entire uterus,
hysterectomy is available to women with long-lasting
or severe symptoms who have no future pregnancy plans. Hysterectomy has both
positive and negative long-term effects. For more information, see the topic
Hysterectomy.

To shrink or destroy fibroids without surgery,
uterine fibroid embolization (UFE) (also called
uterine artery embolization) stops the blood supply to the fibroid. The fibroid
then shrinks and may break down. UFE preserves the uterus, but pregnancy is not
common after treatment. UFE is not usually recommended for women who plan to
become pregnant.3

Another treatment used to destroy
fibroids without surgery is MRI-guided focused ultrasound. This treatment uses
high-intensity ultrasound waves to break down the fibroids. Studies show that
this treatment is safe and works well at relieving symptoms. But more studies
are needed to find out if it works over time.3 This
treatment may not be available everywhere.

There are several other ways of
removing fibroids or killing fibroid tissue using extreme cold (cryomyolysis), or laser (myolysis). But
they are still new enough that risks and long-term benefits are not yet fully
known. If your doctor offers one of these
procedures, ask how many of the procedures he or she has done, how successful
they have been, and what kinds of problems can result. These treatments are not
recommended for women who are trying to become pregnant.4 And these
treatments may not be available everywhere.

Prevention

There is no known treatment that prevents
uterine fibroids. But getting regular exercise may
help. According to one study, the more exercise women have, the less likely
they are to get uterine fibroids.1

Preventing fibroids from coming back after treatment

It is common for fibroids to grow back after treatment. The only
treatment that absolutely prevents regrowth of fibroids is removal of the
entire uterus, called
hysterectomy. After hysterectomy, you cannot get
pregnant. While many women report an improved quality of life after
hysterectomy, there are also possible long-term side effects to think about. For
more information, see the topic
Hysterectomy.

Home Treatment

Home treatment can ease menstrual
period pain and
anemia that may be linked to
uterine fibroids.

Tips for relieving menstrual pain

Painful
menstrual periods (dysmenorrhea) are one of the most common symptoms of
fibroids.

Why fibroids cause pain is not known. Try one or more of
the following tips to help relieve your menstrual pain:

Nonsteroidal
anti-inflammatory drugs (NSAIDs), such as ibuprofen, help relieve menstrual
cramps and pain. Be safe with medicines. Read and follow all instructions on the label.

Apply heat to the lower abdomen by
using a heating pad or hot water bottle or taking a warm bath. Heat improves
blood flow and may improve pelvic pain.

Lie down and elevate your
legs by putting a pillow under your knees. This may help relieve
pain.

Lie on your side and bring your knees up to your chest. This
will help relieve back pressure.

Use pads instead of
tampons.

Get exercise, which improves blood flow and may reduce
pain.

Tips for preventing anemia

Anemia occurs when your body cannot produce blood as
fast as it is being lost. As a result, you have fewer red blood cells in the
blood. A test called a complete blood count (CBC) can tell you whether you have
anemia. Increasing the amount of iron in your diet may help
prevent anemia.

Medications

Medicine can be used to help relieve
uterine fibroid problems. The goals of medicine
treatment are to:

Medicine choices

The following medicines are used to relieve heavy
menstrual bleeding, anemia, or painful periods—they do not shrink
fibroids:

Nonsteroidal anti-inflammatory drug (NSAID) therapy relieves menstrual cramping and
greatly reduces heavy menstrual bleeding for many women. But there are no
studies that show that NSAIDs reduce fibroid pain or bleeding.2

Birth control hormones (pill, patch, or ring) reduce heavy menstrual periods and pain while
preventing pregnancy. But they usually do not affect the size of uterine
fibroids.

An intrauterine device (IUD) that releases small amounts of a certain hormone (levonorgestrel) into the uterus may reduce heavy menstrual bleeding.

A
progestin shot (Depo-Provera) every 3 months may
lighten your bleeding. It also prevents pregnancy. Based on studies,
progestin may improve fibroids or may make them grow.3 This might be different for each
woman.

Iron supplements, available without a prescription, are an
important part of correcting
anemia caused by fibroid blood loss.

The following medicine is used to shrink fibroids before
surgery and to temporarily relieve symptoms:

Gonadotropin-releasing hormone analogue (GnRH-a) therapy puts the body in a state like
menopause, which shrinks the uterus and fibroids.
GnRH-a therapy should be used for only a few months, because it can weaken the
bones. It may also cause unpleasant menopausal symptoms. Fibroids grow back
after GnRH-a therapy is stopped.5

Ulipristal (Fibristal) is used to treat moderate to severe symptoms of fibroids in women who are planning to have surgery. This medicine should not be used for more than 3 months.

What to think about

If you have pain or heavy
menstrual bleeding, it may be from a bleeding uterine fibroid. But it may also
be linked to a
menstrual cycle problem that can be improved with
birth control hormones and/or NSAID therapy. For more information, see the
topic
Abnormal Uterine Bleeding.

GnRH-a therapy is sometimes used to stop
bleeding and improve anemia. But taking iron supplements
can also improve anemia and does not cause the troublesome side effects and
bone weakening that can happen with GnRH-a therapy.

Surgery

To treat
uterine fibroids, surgery can be used to remove
fibroids only (myomectomy) or to remove the entire uterus (hysterectomy).

Surgery is a reasonable treatment option when:

Heavy uterine bleeding and/or
anemia has continued after several months of therapy
with birth control hormones and a nonsteroidal anti-inflammatory drug (NSAID).

Fibroids grow after
menopause.

The uterus is misshapen by
fibroids and you have had repeat
miscarriages or trouble getting pregnant.

Fibroid pain or pressure affects your quality of
life.

You have urinary or bowel problems (from a fibroid pressing
on your bladder,
ureter, or bowel).

There is a possibility
that cancer is present.

Fibroids are a possible cause of your
trouble getting pregnant.

Surgery choices

Surgical treatment options include:

Myomectomy, or
fibroid removal. This may improve your
chances of having a baby if the fibroid is inside the uterus and prevents a fertilized egg from implanting in the uterus. Removing fibroids in other locations of the uterus may not improve your chances of becoming pregnant.

Hysterectomy, or uterus removal. This is only
recommended for women who have no future pregnancy plans. Hysterectomy is the
only fibroid treatment that prevents regrowth of fibroids. It improves quality
of life for many women. But it can also have negative long-term effects. For more information, see the
topic
Hysterectomy.

Myomectomy or hysterectomy can be done through one or
more small incisions using
laparoscopy, through the vagina, or through a larger
abdominal cut (incision). The method depends on your condition, including
where, how big, and what type of fibroid is growing in the uterus and whether
you hope to become pregnant.

What to think about

If you are hoping for a future
pregnancy, myomectomy is your one surgical option.

Heavy, prolonged, and painful periods caused by uterine fibroids will
stop naturally after you reach
menopause. If you are nearing menopause and your
symptoms are tolerable, consider controlling symptoms with home treatment and
medicine until menopause.
Uterine fibroid embolization (UFE) may also be a
reasonable option for you, although it has some risks.

Other Treatment

Uterine fibroid embolization (UFE)
(also called uterine artery embolization) is another option for treating
uterine fibroids. It
shrinks or destroys uterine fibroids by blocking the artery that supplies blood
to them. During a UFE procedure, a radiologist places a thin, flexible tube
called a catheter into the upper thigh and guides it into the uterine artery
that supplies blood to the fibroids. A solution is then injected into the
uterine artery through the catheter.

UFE is a nonsurgical
alternative to
hysterectomy or
myomectomy. It relieves fibroid symptoms for most
women. But in rare cases it can lead to complications such as serious
infection or early menopause.

UFE may be a reasonable treatment
option when:

You have no childbearing plans.
Pregnancy is possible after UFE, but the risks to pregnancy after UFE are not
fully known.

Heavy uterine bleeding
and/or anemia has continued after several months of therapy
with birth control hormones and a nonsteroidal anti-inflammatory drug (NSAID).

You have fibroid pain or pelvic pressure that affects your quality
of life.

You have urinary or bowel problems from a fibroid that is
pressing on your bladder,
ureter, or bowel.

Another treatment used to destroy fibroids
without surgery is MRI-guided focused ultrasound. This treatment uses
high-intensity ultrasound waves to break down the fibroids. Studies show that
this treatment is safe and works well at relieving symptoms. But more studies
are needed to find out if it works over time.3 This treatment may not be available everywhere.

What to think about

In one study, about 1 out of 5
women who had uterine fibroid embolization (UFE) needed another UFE or a
hysterectomy within 3½ years.6

Pregnancy
is possible after UFE. Whenever you need to prevent pregnancy after UFE, be
sure to use a dependable form of
birth control.

Heavy, prolonged, and
painful periods caused by uterine fibroids will stop naturally when you reach
menopause. If you are nearing menopause and your
symptoms are tolerable with home treatment or medicines, then the benefits of UFE
may not outweigh the risks.

There are several other ways of removing fibroids or killing
fibroid tissue, including using extreme cold (cryomyolysis) or laser (myolysis). But
they are still new enough that risks and long-term benefits are not yet fully
known. If your doctor offers one of these
procedures, ask how many of the procedures he or she has done, how successful
they have been, and what kinds of problems can result. These treatments are not
recommended for women who are trying to become pregnant.4 And these treatments may not be available everywhere.

American College of Obstetricians and
Gynecologists (2008, reaffirmed 2012). Alternatives to hysterectomy in the management of
leiomyomas. ACOG Practice Bulletin No. 96. Obstetrics and Gynecology, 112(2, Part 1): 387–399.

Practice Committee of the American Society
for Reproductive Medicine, Society of Reproductive Surgeons (2008). Myomas and
reproductive function. Fertility and Sterility, 90(3):
S125–S130.

American College of Obstetricians and
Gynecologists (2008, reaffirmed 2012). Alternatives to hysterectomy in the management of
leiomyomas. ACOG Practice Bulletin No. 96. Obstetrics and Gynecology, 112(2, Part 1): 387–399.

Practice Committee of the American Society
for Reproductive Medicine, Society of Reproductive Surgeons (2008). Myomas and
reproductive function. Fertility and Sterility, 90(3):
S125–S130.

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use.
How this information was developed to help you make better health decisions.